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Feeding the patients with upper gastrointestinal bleeding

Hébuterne, Xavier; Vanbiervliet, Geoffroy

Current Opinion in Clinical Nutrition & Metabolic Care:
doi: 10.1097/MCO.0b013e3283436dc5
Nutrition and the intensive care unit: Edited by Mette Berger and Jeffrey I. Mechanick
Abstract

Purpose of review: It is usually believed that in case of upper gastrointestinal bleeding patients must be systematically fasted. This review will focus on oral and/or enteral feeding in patients with or at risk of upper gastrointestinal bleeding.

Recent findings: In case of upper gastrointestinal bleeding, an endoscopy is always required in order to determine the pathophysiology of the bleeding, and in some case to perform an endoscopic treatment. In patients hospitalized in ICU, enteral nutrition is the best stress ulcer prophylaxis. In patients with enteral nutrition the concomitant use of histamine-2 receptor blockers or proton-pump inhibitors may be harmful. In case of bleeding due to gastric erosions, enteral nutrition can be resumed as soon as the patient tolerates. In patients with liver cirrhosis nonbleeding oesophageal varices are not a contraindication for enteral nutrition nor nasogastric tube. In patients hospitalized for acute upper gastrointestinal bleeding due to an ulcer with high risk of rebleeding (Forrest I–IIb) or with variceal bleeding it is recommended to wait at least 48 h after endoscopic therapy before initiating oral or enteral feeding. In case of ulcer with low risk of rebleeding (Forrest IIc and III) or in patients with gastritis, Mallory–Weiss, oesophagitis, or angiodysplasia, there is no need to delay refeeding, and they can be fed as soon as tolerated.

Summary: Understanding the cause of the diagnosis is always necessary to adapt nutrition in patients with upper gastrointestinal bleeding.

Author Information

Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia-Antipolis, Nice, France

Correspondence to Professor Xavier Hébuterne, MD, PhD, Archet Hospital, Department of Gastroenterology and Nutrition, 151 Route Saint Antoine de Ginestière, 06202 Nice cedex 03, France Tel: +33 4 92 03 61 68; fax: +33 4 92 03 65 75; e-mail: xavier.hebuterne@unice.fr

© 2011 Lippincott Williams & Wilkins, Inc.